Ataraxia

“ The pain of a gastric neurosis may, indeed, so simulate the gastric crises of locomotor ataxia as to make what is only a case of hysteria seem beyond doubt one of locomotor ataxic. Locomotor ataxia patients are prone to think much about themselves and to fear the recurrence of these painful crises once they have had experience with them. As a consequence they sometimes suffer from what are pseudo-crises, that is, from neurotic painful conditions which simulate genuine crises mainly in the amount of reaction they produce in the patient. ”

“ There has never been a case of true locomotor ataxia cured by any means whatever, in the history of man, until this Kansas surgeon, Dr. Brinkley, found the cure for it in this transplantation of goat-glands. Ataxia is an after-math of syphilis, in ninety-nine cases out of a hundred, and it is a question, which no layman can solve, whether the cause of the ataxia is in the disease, or in the mercurial treatment used to combat the disease. Another age, following this, may decide that the disease, syphilis, is less destructive of human tissue than the cure, Mercury. ”

“ The patient has incoördination; one, therefore, does one's best to teach him to co-ordinate his movements by small beginnings and by small increases.
The lessons may be given by the physician at first and be executed under his eye. After a few days any tolerably intelligent patient should be able to carry them out alone, but still each new movement should be personally inspected to make sure that it is done correctly.
In patients in the first stage of ataxia the most striking result of incoördination is the impairment of station. We therefore begin with balancing lessons. ”

“ The loss of the sense of touch in the skin is not, however, the sole or even chief reason that the ataxic man cannot walk. I once saw a patient who could march very well by night or by day, although [Pg 634] the skin of his legs was so dead that a live coal would scarcely awaken it. The sense that is wanting in locomotor ataxia is that form of general sensibility which is known as the muscular sense; that is, that sense or feeling which tells the lower brain exactly how much a muscle is contracted, and when to urge it more, when to let it relax. ”

“ In some examples of its spinal form locomotor ataxia is undoubtedly an extremely chronic disease, with few and imperfectly developed symptoms; and it is thus not unnatural to expect that similar limitations may obtain in the ocular manifestations of the disease. That evidences of grave nervous disease may be limited to the pupil is well seen in Case XVIII., where a syphilitic patient was under observation for three years without the discovery of any abnormality other than paresis of each sphincter iridis. ”

“ Of course, in those cases in which there exists only a single ocular symptom unaccompanied by any sign of spinal disease, it may be objected that it has yet to be demonstrated that such cases are of the nature of locomotor ataxia. It is doubtless to be desired that such cases should be under exact observation as long as the opportunity for further developments exists—that is, for the entire life of the patient. ”

“ Patient was unable to walk or stand, and had no control over her bladder. The knee-jerks and ankle-jerks absent on both sides; ataxia in the leg movements; loss of sense of localization, 268with no tenderness over the nerve trunks; no atrophy, paralyses, or muscular asymmetry of the parts. The vibratory sense was maintained. Subjectively, the patient thought that the vibratory sense differed in the legs from that in the arms. Localization, touch, pain, heat, and cold responded to correctly. The arms showed nothing abnormal; there was no incoördination, dysmetria, or dysdiadochokinesis. ”

“ If these are absent or perverted or deficient, as is the case in the disease known as locomotor ataxia, then, although there is no loss of the power of voluntary movement, the patient staggers in walking, especially if he is not allowed to look at his feet, or if he is blind-folded. ”

“ Again, whenever we endeavor to estimate accurately how heavy a body is, we raise it again and again into the air, evidently that we may feel the muscles contract again and again, and by repeated efforts judge how much of force they put forth.
The phenomena of ataxia are of great importance as corroborating the experimental proofs spoken of a few pages back, which show that walking is automatic and not simply performed by a conscious power of the will. Thus the ataxic may be able to walk with his eyes open, when he cannot even balance himself erect with his eyes shut. ”

“ The doings of Artashes are known to thee, through the epical songs which are sung in the province of Goghtan; that is to say, his founding of Artaxata (Artashat) ,16 his alliance by marriage with the royal house of the Alans, his sons and their descendants, the loves of Satenik with the Vishapazuns (progeny of dragons) who were of the race of Astyages; his wars with them, the overthrow of their dynasty, their slaughter, the burning of their palaces, the rivalries of the sons of Artashes, the intrigues of their wives, which further fomented the discord amongst them. ”

“ The disturbance of co-ordination above spoken of as manifested in the inability of the patient to stand well with his eyes closed is the first step in the development of the characteristic ataxia which marks the full-blown affection. The patient finds that he tires more and more on slight exertion—not because his muscles are weak, but because he has to make more voluntary effort than a person in health. He finds that he stumbles easily—is unable to ascend and descend at the curbstone or to walk over an irregular surface with ease. Going down stairs is peculiarly irksome. ”

“ It is now generally recognized that the disease known as locomotor ataxia may include among its clinical manifestations symptoms other than those which depend on pathological changes in the spinal cord. A number of these are associated with the functions of the eyeballs. The Argyll-Robertson pupil is universally admitted as valuable confirmatory evidence of a diagnosis of locomotor ataxia; ocular paralyses, if less frequent, are certainly not less significant ”

“ Parysatis kept Gigis at home with her a long time, and, though the king commanded her, she would not produce her. But she, at last, herself desiring that she might be dismissed to her own home by night, Artaxerxes had intimation of it, and, lying in wait for her, hurried her away, and adjudged her to death. Now poisoners in Persia suffer thus by law. There is a broad stone, on which they place the head of the culprit, and then with another stone beat and press it, until the face and the head itself are all pounded to pieces ”

“ Artaxerxes, now being an old man, perceived that his sons were in controversy about his kingdom, and that they made parties among his favorites and peers. Those that were equitable among them thought it fit, that as he had received it, so he should bequeath it, by right of age, to Darius. The younger brother, Ochus, who was hot and violent, had indeed a considerable number of the courtiers that espoused his interest, but his chief hope was that by Atossa's means he should win his father. ”

“ In the third, the paralytic stage, which seldom comes on until the symptoms have lasted for years, there is gradual loss of power and ataxia, increasing until he is totally unable to walk. If a patient is not seen until this condition of things has been reached, but little can be hoped from any treatment, though in a few cases energetic measures may bring about a marked improvement, which is rarely lasting. ”

“ He got up, sat down again, and finished by resting his elbow on the partition and conversing in an undertone with a patient who sat against this same partition in the next compartment. The patient in question was a thick-set man of fifty, with a good-natured face and a large head, completely bald. His name was Sabathier, and for fifteen years he had been stricken with ataxia. ”

“ In patients who cannot walk, ataxia may be tested by ordering repeated pronation and supination of the forearm. Paresis or asthenia may be found in the trunk muscles, or evidenced by weakness of the grip, or drooping of the head to one side. Changes in muscle tone may arise and lead to exaggerated or decreased reflexes, often varying from day to day. Vertigo and nystagmus may also be present, in addition to occipital headache and tenderness on percussion. When one lateral lobe is implicated, the symptoms are referred to the same side ”

“ However, Artaxerxes consented to the entreaties of his mother, and promised her with an oath that he would spare Clearchus; but afterwards, at the instigation of Statira, he put every one of them to death except Menon. And thenceforward, he says, Parysatis watched her advantage against Statira, and made up poison for her; not a very probable story, or a very likely motive to account for her conduct, if indeed he means that out of respect to Clearchus she dared to attempt the life of the lawful queen, that was mother of those who were heirs of the empire. ”

“ Most of the later victories of Artaxerxes were due to the valor of his Greek auxiliaries, or to the treachery or incapacity of his opponents. After the reëstablishment of his government, he abandoned himself to the pleasures of his palace, while the control of affairs rested exclusively with Bago ́as, his minister, and Mentor, his general. The people were only reminded from time to time of his existence by some unusually bloody mandate. Whatever hope might have been inspired by his really great abilities, was disappointed at once by his unscrupulous violence and indolent self-indulgence. ”

“ As he well knew that Artaxerxes was sure to occupy the centre of his line of battle, he should have placed his Greeks in the middle of his own line, not at one extremity. When he saw how much his adversary outflanked him on the left—a contingency which was so probable that it ought to have occurred to him beforehand—he should have deployed his line in that direction, instead of ordering such a movement as Clearchus, not unwisely, declined to execute. He might have trusted the Greeks to fight in line, as they had fought at Marathon ”

“ They are terrible men! They deal with the demons of the hills and mountains. They sacrifice to them, even offering up human lives sometimes. They are able to read one’s thoughts. They bring up the dead and make them talk. Only Ahura-Mazda can protect you, and I know not if He will!”
“Be comforted, child,” said Athura, calmly. “Let us escape in some manner. Once before I fled from a prison when Cambyses would have slain me. Is there no way of escape?” ”

“ Artaxerxes was easily persuaded, and, with the assistance of the guards, kills his brother. Artabanus seeing his treachery succeed according to his heart's desire, now boasts before all his sons that the time was come for his advancement to the kingdom, and forthwith comes to Artaxerxes with his sword drawn, and wounds him. The king not being much hurt, bravely defends himself, and kills Artabanus upon the place. ”

“ I am far from serenity, I fear—for I am filled with unrest—I try to tell myself that Alathea Sharp does not matter in my life at all—that this is the end—that I am not to be influenced by her movements or her thoughts, or her comings and goings—I try not to think of her even as "Alathea"—And then when I have succeeded in some measure in all this, a hideous feeling of sinking comes over me—that physical sensation of a lead weight below the heart. What on earth is the good of living an ugly maimed life? ”

“ In some cases the disease attacks the membranes of the brain and the small blood vessels giving rise to a still different type of mental disorder. Practically all patients with locomotor ataxia owe their condition to an antecedent syphilis. Moreover it is one of the important causes of arterio-sclerosis, or hardening of the blood vessels, and is also a prominent factor in certain forms of heart-disease, as well as by no means an unimportant cause of blindness in children. ”

“ The inability to feel the contact of the ground or floor with the feet occasions the difficulty in walking. The causes of this disease are somewhat obscure, but unquestionably exposure to cold and dampness, and over-mental work, are largely instrumental in its production. Scrofula and syphilis favor its development, while abuse of the nervous system, such as results from over-indulgence of the animal and reproductive instincts, are frequent sources of the nervous changes that lead to ataxia. ”

“ Artaxias had been governor of the Greater Armenia under Antiochus, and seized the opportunity afforded by the battle of Magnesia to change his title of satrap into that of sovereign. No war followed. Antiochus was too much weakened by his reverses to make any attempt to reduce Artaxias or recover Armenia; and the nation obtained autonomy without having to undergo the usual ordeal of a bloody struggle. When at the expiration of five-and-twenty years Epiphanes, the son of Antiochus the Great, determined on an effort to reconquer the lost province, no very stubborn resistance was offered to him. ”

“ Artaxerxes represents himself as receiving the Persian diadem from the hands of Ormazd; both he and the god are mounted upon chargers of a stout breed, which are spiritedly portrayed; Artabanus lies prostrate under the feet of the king’s steed, while under those of the deity’s we observe the form of Ahriman, also prostrate, and indeed seemingly dead. Though the tablet has not really any great artistic merit, it is far better than anything that remains to us of the Parthians; it has energy and vigor ”